Concierge Practice Gives Doc More Time With Patients

North Raleigh physician is state's first embracing hybrid medical model

Dr. Octavian Belcea thinks of himself as a medical throwback, the friendly family doctor who practices old-fashioned, comprehensive treatment of his patients and their families.

He’s doing so using advanced medical technology in the state’s first-of-its-kind hybrid “concierge” Wakefield Family Medicine practice in north Raleigh. Just over a month ago Belcea joined Concierge Choice Physicians, the nation’s second-largest, full-service, concierge medical service provider.

Concierge care is an alternative catching on across the country. Through CCP’s trademark Hybrid Choice program, Belcea’s patients may maintain their traditional model of insurance-based health care. Or they could opt for concierge medicine, under which patients pay an annual retainer fee and in return receive longer consultations during their office visits, along with Belcea’s promise to track patients’ medical conditions more closely and follow up as he or they see a need to do so.

“We have worked today for over 300 practices with over a half-million patients and tens of thousands of members,” said Wayne Lipton, CCP managing partner. “We have steadily grown since we started 10 years ago. We believe that the growth will accelerate dramatically in the coming years as a result of the rapid changes in the health care landscape.”

Elaine Ellis, spokeswoman for the North Carolina Medical Society, said the organization doesn’t have “any formal position on concierge medicine one way or the other.”

“It’s really what I used to provide when I first opened the office,” Belcea said. “As time went on, and things got busier, I kind of noticed that I lost that feeling of being different. By starting this program I’m basically able to get that feeling back, and the patients appreciate it.”

His patients have noticed the changes in health care, “and how everybody’s rushed to get in and out,” he said. The national average of eight minutes of face time with a doctor during an office visit is insufficient to perform a thorough interview and examination, he said. That’s part of the reason so many tests are ordered — to fill in the blanks, which drives up health care costs.

That harried, assembly-line style of medicine drove Belcea into solo practice after graduating in 2003 from the UNC-Chapel Hill Family Medicine Program.

“I thought that I could do better than that,” he said of the eight-minute office visits. So he became the first — and last — resident since 1986 to open a solo practice in the state.

“I had plenty of time with patients, phone calls, emails, urgent visits. It was great,” Belcea said of his early experience. “It was exactly what I dreamed primary care should be like.”

Today he believes he is one of only two board-certified, solo practice family physicians remaining in the Raleigh area.

“Everybody else works for some big corporation or hospital. And what does a corporation care about? Money. ‘Hey doc, you’ve got to see 40 patients today to make the quota,’” Belcea said. “Well, how can you have time to do anything, follow up with endocrinologists, pulmonologists, or look at all that stuff? It’s impossible.”

He began working longer hours and Saturday shifts. Appointment times were growing shorter as he struggled to compete financially. He had a master’s degree in computer science, and was reconsidering his career.

“One of the options was I could just shut down the office, and go back to computer science, and probably make more money doing that,” Belcea said. “Another option was to sell the office. And then the third option was to do the concierge program.”

He describes the concierge program as “additional testing, additional care, additional time to spend in detail, and follow-ups with hospitals, and follow-ups” with consulting physicians.

“When you get an x-ray done you want to make sure it was done correctly. And that’s basically what concierge medicine is,” he said. “Traditional medicine is you order a test, and you hope the patient goes to do it.”

More than half the time hospitals don’t inform him his patients were seen or admitted. “A lot of times I don’t even get a discharge summary from the hospital,” Belcea said. It’s frustrating, and time-consuming.

The annual concierge retainer is $1,650, or $137.50 monthly. That extra revenue helps him financially, and allows him to expand visit and walk-in times for concierge participants.

Patients can use their insurance and their flexible spending accounts to pay for office visits, co-payments, deductibles, and other health care costs.

Those features distinguishes concierge care from direct primary care, which also operates on a retainer basis but usually does not accept insurance. Federal law bars patients from using flexible spending accounts for direct care.

Under the concierge model, one annual office visit is not covered by insurance. During that visit, Belcea orders any bloodwork or other screening tests he deems necessary to evaluate a patient.

“Because I’m providing a noncovered service, there’s no insurance issues. The patient signs, I agree to [order] the service, and I agree to pay for it,” Belcea said.

“Not everybody can afford it, and that’s why I decided to do the hybrid program because I don’t want to turn my back on anyone,” Belcea said. Under a full concierge practice, all patients are required to pay the annual fee and join the program. Patients choosing not to join a full concierge plan would be severed from that practice, and would need to find another doctor.

The hybrid model allows him to treat Medicare patients, Belcea said. As Medicare costs rise and reimbursement to doctors keep being squeezed, he said, patients “will not be able to find another doctor that takes Medicare. I’m going to continue seeing everybody.”

All of the administrative and financial work on the concierge side is performed by CCP, reducing his overhead costs. CCP sent a full-time staff person to work in his office during his start-up, took care of advertising, and handled phone calls and follow-up conversations on a toll-free line.

His concierge patients can use CCP’s network of concierge doctors if an emergency arises when traveling; the physicians consult with Belcea.

All patients are given a USB thumb drive containing their medical information and history that’s available to other physicians in the network. The thumb drive also contains their DNA information, which is updated continually to a global genetic database, indicating potential health risks and allowing preventive care to be customized.